Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 1 2024 01 01 116 125 EN Heakyong Lee Graduate School of Alternative Medicine, Kyonggi University (Seoul Campus), Seoul, Republic of Korea Jaehee Kim Graduate School of Alternative Medicine, Kyonggi University (Seoul Campus), Seoul, Republic of Korea 2022 08 12 2023 01 15 Background: Positive and negative emotions have recently revealed a link with primary dysmenorrhea in adults. Among them, roles of stress and self-esteem have been less studied specially in adolescents and the direction of causality has not been clearly established. Therefore, this study investigated whether stress and self-esteem independently affect primary dysmenorrhea after adjustment for the known risk factors in adolescents. Additionally, indirect effects of stress and self-esteem were determined using mediation analyses. Methods: This survey was conducted in adolescent girls aged 15-18 yr in metropolitan regions in South Korea in 2021. The survey included general, menstrual, and lifestyle characteristics, menstrual pain and symptom, perceived stress, self-esteem, depression, and state-trait anxiety. Results: Stress, depression, and anxiety were associated positively with menstrual pain and symptom (all P<0.001) in adolescent girls (n=519). Self-esteem was also associated inversely with negative emotions and dysmenorrhea (all P<0.001). Additionally, stress independently affected frequency and severity of menstrual symptom (both P<0.05), but not pain intensity after adjustment for covariates. Stress also had indirect effect through depression and anxiety on menstrual pain and symptom. Effect of self-esteem vanished after adjustment for covariates, but indirectly reduced menstrual pain and symptom through mediations of stress, depression, and anxiety. Conclusion: Mental health such as stress and self-esteem are important for managing menstrual pain and symptom in adolescents. It should be considered in managing dysmenorrhea. https://ijph.tums.ac.ir/index.php/ijph/article/view/29542 https://ijph.tums.ac.ir/index.php/ijph/article/download/29542/8136